*Date of Submission:
*Reimbursement check issued to:
*Total amount of check:
Please have ready all applicable receipts with a circle around the amount to be reimbursed. Note on each receipt the fund or event associated or the item purchased is for.
This form is for PASTORAL STAFF ONLY. All others, if you have not filled out and have a pre-approved Purchase Order, reimbursement is not guaranteed.
*Name of submitter:
*Email of submitter:
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